2022

2022 Vision Summary of Benefits Small Business (1 to 100)

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Summary of Benefits

When providing a summary of benefits to an applicant or Blue Shield member, you must also include a Disclosure and a Notice of Language Assistance. (PDF, 1MB)

How to read plan names: Eye exam copayment/materials copayment/frame allowance. 'Plus' plans include additional benefits for contact lens materials and fitting.

 

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Plan Names Summaries of Benefits Disclosures
Basic Vision for Small Business 0/0/120 English
Spanish		 English
Basic Vision for Small Business 0/0/150 English
Spanish		 English
Basic Vision for Small Business 10/25/120 English
Spanish		 English
Basic Vision for Small Business 10/25/150 English 
Spanish		 English
Basic Vision Plus for Small Business 0/0/150/150 English
Spanish		 English
Basic Vision Plus for Small Business 10/25/150/150 English
Spanish		 English
Basic Vision Voluntary for Small Business 10/25/120 English
Spanish		 English
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Plan Names Summaries of Benefits Disclosures
Preferred Vision for Small Business 0/0/120 English
Spanish		 English
Preferred Vision for Small Business 0/0/150 English
Spanish		 English
Preferred Vision for Small Business 10/25/120 English
Spanish		 English
Preferred Vision for Small Business 10/25/150 English
Spanish		 English
Preferred Vision Plus for Small Business 0/0/150/150 English
Spanish		 English
Preferred Vision Plus for Small Business 10/25/150/150 English
Spanish		 English
Preferred Vision Voluntary for Small Business 10/25/120 English
Spanish		 English
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Plan Names  Summaries of Benefits  Disclosures
Ultimate Vision for Small Business 0/0/120 English
Spanish		 English
Ultimate Vision for Small Business 0/0/150 English
Spanish		 English
Ultimate Vision for Small Business 10/25/120 English
Spanish		 English
Ultimate Vision for Small Business 10/25/150 English
Spanish		 English
Ultimate Vision Plus for Small Business 0/0/150/150 English
Spanish		 English
Ultimate Vision Plus for Small Business 10/25/150/150 English
Spanish		 English
Ultimate Vision Voluntary for Small Business 10/25/150 English
Spanish		 English
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Plan Names Summaries of Benefits Disclosures

Ultimate Vision for Small Business 15/25/120		 English
Spanish		 English
Ultimate Vision Plus for Small Business 15/25/150/150 English
Spanish		 English
Ultimate Vision Voluntary for Small Business 15/25/150 English
Spanish		 English
Ultimate Vision for Small Business 15/25/150 English
Spanish		 English
Preferred Vision Plus for Small Business 15/25/150/150 English
Spanish		 English
Preferred Vision Voluntary for Small Business 15/25/120 English
Spanish		 English
Preferred Vision for Small Business 15/25/120 English
Spanish		 English
Preferred Vision for Small Business 15/25/150 English
Spanish		 English
Basic Vision for Small Business 15/25/120 English
Spanish		 English
Basic Vision for Small Business 15/25/150 English
Spanish		 English
Basic Vision Plus for Small Business 15/25/150/150 English
Spanish		 English
Basic Vision Voluntary for Small Business 15/25/120 English
Spanish		 English

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    Chico, CA 95927-2540

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